Clinical Diagnosis of Heart Failure Bernard M. Karnath, MD Choose the single best answer to each question. 1. A 63-year-old woman with newly diagnosed heart failure presents for a follow-up visit. She was diagnosed with heart failure during a hospitalization for dyspnea 1 month ago. Her medications include enalapril 10 mg daily, carvedilol 6.25 mg twice daily, and furosemide 20 mg twice daily. An echocardiogram performed during admission revealed a left ventricular ejection fraction of 30%. According to the patient’s current report, she is comfortable at rest, but ordinary physical activity results in symptoms. How should this patientŐs heart failure be classified using the New York Heart Association (NYHA) classification system? Class I Class II Class III Class IV Click here to compare your answer. 2. A 55-year-old man with a 10-year-history of hypertension presents for routine follow-up. He is currently taking hydrochlorothiazide 25 mg daily and enalapril 10 mg daily. A routine interval electrocardiogram reveals left ventricular hypertrophy. Upon further review of systems the patient reports some mild dyspnea on exertion. What is the current stage for this patient’s heart failure based on the American College of Cardiology/American Heart Association staging system? Stage A Stage B Stage C Stage D Click here to compare your answer. 3. A 59-year-old man who has been experiencing progressive dyspnea for the past 3 months presents for evaluation. Review of systems reveals that he has been experiencing dyspnea on exertion, orthopnea, and a nocturnal cough. Physical examination is significant for bilateral ankle edema. According to the Framingham criteria for congestive heart failure, which of this patientŐs findings is considered a major criterion? Bilateral ankle edema Dyspnea on exertion Nocturnal Cough Orthopnea Click here to compare your answer. 4. A 60-year-woman presents to the emergency department for evaluation of a 3-week history of dyspnea. Her past medical history is significant for a 10-year history of both hypertension and diabetes. Social history is significant for a 30-pack year history of smoking. The physician is concerned about new-onset heart failure. In addition to a full history and physical examination, which of the following laboratory examinations would be most helpful in determining whether this patient’s dyspnea is due to heart failure? B-type natriuretic peptide Cardiac enzymes Chest radiograph D-dimer test Electrocardiogram Click here to compare your answer. Click here to read more about Clinical Diagnosis of Heart Failure (Requires Adobe Acrobat Reader) Check our archives to test your knowledge in other clinical signs: If you do not already have Acrobat Reader, simply click on the icon below, scroll down to the "Get the Free Acrobat Reader" heading and follow the instructions to install the program. Acrobat enables you to convert any document into an Adobe Portable Document Format (PDF) file for easy viewing. Download Adobe Acrobat Reader   Hospital Physician     JCOM     Seminars in Medical Practice Hospital Physician Board Review Manuals About TWC    Subscribe    Contact TWC    Home    Search   Site Map Copyright © 2009, Turner White Communications Updated 12/29/09 • mcf